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266 Cards in this Set
- Front
- Back
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If assessing cardiovascular problems skin might be
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cyanotic and pale
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Unusual pulsations may be present where with cardiac problems?
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neck
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What do the fingers look like in a person with cardiac problems?
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clubbed
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What position do toddlers stay in when they are having cardiac problems
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squatting
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What diagnosis is often associated with heart disease
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failure to thrive
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What might you hear in the chest with cardiac problem assessment?
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thrills
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What happnes to the abdomen during cardiac problems?
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back up of fluids into the organs
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If fluid in the lungs, what heart sounds will you hear and where?
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rales at bases
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When doing a cardiac assessment where do you want to take the blood pressure?
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all 4 extremities
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When assessing the general appearance for a child with cardiac problems what is an important aspect?
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knowing the norms for each child
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What cardiac diagnostic test must only be performed on older children
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exercise stress test
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Includes primariy anatomic abnormalities present that result in abnormal cardiac function
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congenital heart disease
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Congential heart disease causes what at birth?
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circulatory changes
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Blood flow from the left side of the heart to the right side through some abnormal opening or connection between the system or great arteries causes
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increased pulmonary blood flow
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ASD, VSD, Patent ductus arteriousus all cause
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increased pulmonary blood flow
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An obstruction or narrowing (stenosis) in a vessel or valve prohibiting enough blood from reaching its intended site is caused by
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obstructive defects
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Coarctation of the aorta, aortic or pulmonis stenosis are all
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obstructive defects
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An obstruction of pulmonary blood flow and an anatomic defect between left and right side of heart causes
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decreased pulmonary blood flow
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When pressure in the right side of the heart is greater than the left it causes
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decreased pulmonary blood flow
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Tetrology of fallot and tricuspid atresia cause
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decreased pulmonary blood flow
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Causes mixing of the blood from the pulmonary and systemic circulation in the heart chambers
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mixed defects
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Transposition of the freat vessels, total anomalous pulmonary venous connection, truncus arteriouus and hypoplastic left heart syndrome are all what?
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mixed defects
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The inability of the heart to pump an adequate amount of blood to the systemic circulation at nomral filling pressures to meet the metabloic demands of the body
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Congestive Heart Failure
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4 goals of treatment for CHF
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1. Improve Cardiac function
(inc. contractility and dec. afterload) 2.Remove accumulated fluid and sodium (dec. preload) 3. dec. cardiac demands 4. improve tissue oxygenation and decrease oxygen consumption |
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Digoxins role in treatment of CHF
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To improve cardiac function by increasing contractility and decreasing afterload
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Lasixs role of treatment in CHF
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Remove accumulated fluis and sodiem by decreasing preload
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Meds for CHF
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Digoxin and Lasix
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When should you give Digoxin
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At regular intervals 12 hours apart; 1 hour before meals or 2 hours after
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If you miss a dose, if how many hours pass should you give at the next regular time
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4
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On Digoxin treatment when should you call the health care provider
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If more than 2 consecutive doses have been missed or if child is ill
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Can parents let thier babies with CHF cry
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not for an extended period of time
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How are babies with CHF fed?
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NG tubes
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How much activity can babies with CHF tolerate
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they decide on their own
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What is the most common acquired heart disease?
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hyperlipidemia (hypercholesterolemia)
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etiology of Kawasaki Disease
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unknown but involves primarily the cardiovascular system
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What is anohter name for Kawasaki disease
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mucocutaneous lymph node syndrome
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Manifestations of acute phase of Kawasaki
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fever that stays and irritability
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Manifestations of subacute phase of Kawasaki
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resolution of fever
coronary artery aneurysm |
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Manifestations of convalescent phase of Kawasaki
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symptoms have resolved at about 6-8 weeks after onset
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Diagnostic Criteris of kawasaki disease
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5 out of following 6 including fever:
1. fever for more than 5 days 2.red eyes 3. "strawberry tongue" 4.swollen and red extremities 5. polymorphous rash 6. lymph node >1.5 cm. |
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The following criteria are diagnostic for what?
1. fever for more than 5 days 2.red eyes 3. "strawberry tongue" 4.swollen and red extremities 5. polymorphous rash 6. cervical lymphadenopathy |
kawasaki disease
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treatment for Kawasaki Disease
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gamma globulin and high doses of aspirin
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What is important to remember when treating a patient with Kawasakis
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take vitals every hour
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Prevention of shock
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wearing seat belt
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Prevention of hypertension
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exercise nutrition and not smoking
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What is the most common form of cardiac disease in children
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congeital heart disease
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What prenatal afctors may predispose children to CHD?
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maternal rubella, alcoholism, age older than 40, and type 1 diabetes
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Clinical consequences of congenital heart defects include
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CHF and hypoxemia
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Clinical manifestations of CHF are:
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impaired myocardial function, pulmonary congestion, and systemic congestion
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Clinical manifestations of hypoxemia are:
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cyanosis, polycythemia, clubbing, and delayed growth and development
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The child with hypoxemia is at increased risks for
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cerbrovascular accidents, brain abscess, and bacterial endocarditis
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How do you prevent bacterial endocarditis in children with CHD
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administering prophylactic antibiotics when procedures are performed
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A systemic inflammatory disease that can damage the cardiac valves and is associated with previous group A streptoccaal infection
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acute rheumatic fever
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Acute rheumatic fever is associated with what previous condition
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group A streptococcal infection
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An extensive inflammation of small vessels and capillaries that may progress to involve the coronary arteries, causing aneurysm formation
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Kawasaki disease
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: tachycardia
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myocardial function
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: sweating
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myocardial function
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: decreased urine output
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myocardial function
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: fatigue
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myocardial function
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: weakness
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myocardial function
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: restlessness
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myocardial function
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: anorexia
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myocardial function
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: pale,cool extremeities
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myocardial function
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: weak peripheral pulses
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myocardial function
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: decreased blood pressure
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myocardial function
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: gallop rhythm
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myocardial function
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: cardiomegaly
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myocardial function
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: tachypnea
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pulmonary congestion
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: dyspnea
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pulmonary congestion
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: retractions
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pulmonary congestion
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: flaring nares
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pulmonary congestion
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: exercise intolerance
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pulmonary congestion
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: orthopnea
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pulmonary congestion
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: cough, hoarseness
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pulmonary congestion
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: cyanosis
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pulmonary congestion
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: wheezing
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pulmonary congestion
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: grunting
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pulmonary congestion
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: weight gain
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systemic congestion
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion:hepatomegaly
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systemic congestion
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: peripheral edema
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systemic congestion
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: ascites
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systemic congestion
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Impaired Myocardia function, pulmonary congestion or systemic venous congestion: neck vein distention
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systemic congestion
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Right-sided failure causes
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systemic venous congestion
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Left-sided failure causes
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pulmonary congestion
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O2 consumption of a child is ___ than that of an adult
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greater
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Children loss fluid ___ than adults
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quicker
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Children have __ antibodies than adults
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less
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What assessments need to be included in the respiratory function assessment of a child
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GI and occasionally cardiac and neuro
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How do you ease respiratory effort in children with respiratory problems?
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warm or cool mist
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How do you promote comfort in children with respiratory problems
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blow nose, nose drops w aspirator and tylenol
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How do you prevent spread of infection in children with respiratory problems
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Hand washing
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Why do you want to discourage milk when promoting hydration in children?
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milk increases flem
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When do you give a child Pedialite?
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before 6 months of age
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Upper respiratory infections consist primarily of
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the nose and pharynx
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lower respiratory infections consist primarily of
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the bronchi, bronchioles, alveoli, and trachea
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Croup syndromes include
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the epiglottis and larynx
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Pharyngitis is aka
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strep throat
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80-90% of pharyngitis is caused by
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Group A B-hemolytic streptococci
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If pharyngitis is caused by strep children are at risk for developing
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acute rheumatic fever and acute glomerulonephritis
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If viral in origin how do you treat pharyngitis
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treat symptoms only
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If positive culture pharyngitis how do you treat?
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antibiotics
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When are children with pharyngitis no longer contagious?
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With 24 hours of antibiotics and afebrile
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How do you treat tonsillitis?
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antibiotics if bacterial
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Indicated for recurrent strep infections, hx of recurrent peritonsillary abscess, or hypertrophy causing breathing difficulties
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tonsillitis
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Indicated if obstruction of nasal passageway
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Adenoidectomy
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Post-Op priorities for tonsillectomy
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place on side
assess for bleeding and swelling shut of airway |
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What is common after a tonsillectomy
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dehydration
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An inflammation of the middle ear without reference to etiology or pathogenesis
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Otitis Media
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How long does acute otitis media last?
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~ 3 weeks
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an inflammation of the middle ear in which a collection of fluid is present in the middle ear space
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Otitis Media with effusion
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How long does chronic otitis media with effusion last
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beyond 3 months
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AOM is frequently caused by
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streptococcus pneumonia and haemophilus influenzae
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Otitis Media is primarily the result of
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dysfunctioning eustachian tubes
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What is tympanometry?
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measures the movement of the eardrum---fluid in middle ear decreases movement
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When should you do a hearing evaluation in otitis media?
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if child has fluid in both middle ears for a total of 3 months
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Antibiotic for otitis media only if
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child has had more than three ear infections in the past year, positive respiratory culture, or at risk for bacterial infection
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What antibiotic do you use for otitis media?
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amoxicillin
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Surgical incision in the ear drum that drains fluid form the middle ear
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myringotomy
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Why is it better to use antibiotic ear drops rather than oral for otitis media?
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there is not as much blood supply in the middle ear
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What is the most common croup syndrome?
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acute laryngotracheobronchitis
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Acute Laryngitis presentation
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hoarseness and systemic manifestations
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General term applied to a symptom complex characterized by hoarseness, a resonant cough described as "barking" or "brassy"
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Croup syndrome
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Croup syndrome is caused by
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swelling or obstruction in the resion of the larynx
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Croup syndrome will have varying degrees of
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inspiratory stridor and respiratory distress
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Therapeutic management of croup syndrome
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maintaining airway with cool mist humidifier and providing for adequate respiratory exchange also maintain hydration
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How long does racemic epinephrine last?
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2 hours
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what is important to know about racemic epinephrine?
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there is a risk for rebound
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Is respiratory rate is over 160 in children with respiratory problems....
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NPO- risk for aspiration!
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What are signs and symptoms of impending airway obstruction?
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increase or decrease in noises
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Three parts to respiratory assessment
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1.retractions
2.lung sounds 3. equality |
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Sigsn and symptoms of acute epiglottis
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dysphonia
dysphagia drooling distressed respiratory effort |
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How can you tell a child with acute epiglottis is in ditress?
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look sick sitting upright with chin poked out
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When should throat inspection for acute epiglottis be performed?
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Only when immediate intubation can be performed
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How does throat look in acute epiglottis?
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red and inflamed with large swollen epiglottis
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What is the treatment for acute epiglottis?
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antibiotics, intubation and tracheotomy
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How can you prevent acute epiglottis
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HIB Vaccine
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What lower airway infetion is not as common in children?
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bronchitis
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What is the common "cold"
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respiratory syncytial virus
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What causes respiratory syncytial virus?
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mucus and swelling
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Treatment for RSV?
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suctioning and Ribaviron in extreme cases
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RSV is rare in children
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over 2
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Prevention of RSV
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IV RSV immune globulin or Synagis
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When do you give Synagis?
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once a month during high risk months
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RSV may lead to
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asthma
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Acute inflammation in the lungs
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pneumonia
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S&S of pneumonia (6)
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fever
unproductive -productive cough no sounds- fine crackles retractions nasal flaring pallor-cyanosis |
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most common cause of pneumonia
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virus
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Acute respiratory infection caused by Bordetella pertussis
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pertussis
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S&S of pertussis
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continuous cough and cannot catch thier breath
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Is pertussis contagious?
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very
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Treatment for pertussis
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erythromycin
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Cause of tuberculosis
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Myobacterium tuberculosis
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Proliferation of epithelial cells surround and encapsulate the mutiplying bacilli in an attyempt to wall it off
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tuberculosis
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Mantoux test is
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Purified protein derivative
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Positive PPD
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pt has been infected and developed sensitivity but may not have active disease
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Treatment for TB
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Isoniazid, Rifampin and Pyrazinamide combo
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TB regimen
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INH, Rifampin, ad PZA daily for first 2 months........ and INh and Rifampin given twice weekly for the remaining 4 months
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Prevention of TB
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avoid infected and unpasteurized milk
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What is gastric washing?
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aspiration of contents from fasting stomach to test for TB
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Chronic inflammatory disorder of the airways
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asthma
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What is the most common chronic disease in childhood?
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asthma
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Pathphysiology of asthma
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mucus membranes infalme which leads to airway constriction
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What is used to relieve bronchospasm in asthma
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Nebulizer or MDI (Albuterol or Preventil)
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How do you use an MDI correctly?
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1 puff....wait one minute...take second puff
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Peak flow meters assess
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peak expiratory flow rate
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When should they use peak flow meters?
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on a dialy basis
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Green PEFR
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80-100%
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Yellow PEFR
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50-80%
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Red PEFR
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<50%
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If O2 sats under 90%
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put on 2 liters of oxygen
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How often do you assess and take vitals in asthma patients
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every hour and before and after treatments
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If child is using face mask what should the O2 be set on
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no less than 5 l.
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When should a spacer be used?
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recommended for everyone
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At what age can a child handle a mouthpiece instead of a mask?
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5-7 yrs
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How long does it take to administer a nebulizer treatment?
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~20 minutes
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Effectiveness of nebulizer
|
they do not get 100% of med.
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An agitated child who suddenly becomes quiet is a sign of
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resp. distress
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Unrelenting severe respiratory distress and bronchospasm in an asthmatic child, which persist despite pharmacologic and supportive interventions
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status asthmaticus
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When do you admit a status asthmaticus to ICU
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siginifcant hypoxemia (less than 90 O2)
hypercarbia peak expiratoty flow rate <25% |
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How do you treat status asthmaticus
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continuous nebulized albuterol and IV meds such as cortocosteroids and aminophylline
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Autosomal recessive disease that affects the repiratory and GI systems
|
cystic fibrosis
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pathophysiology of cystic fibrosis
|
increased mucus production in lungs and GI tract
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Cystic fibrosis interventions
|
aerosal therapy, CPT and postural drainage, IV antibiotics, and oxygen if needed
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Home care for cystic fibrosis
|
high calorie and protein diet
pancreatic enzymes and vitamins home IV and drainage systems |
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Cystic fibrosis prognosis
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30 to 40 years max
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What is the leading cause of death for infants beyond the neonatal period?
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SIDS
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What is the most common inherited disease in children?
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cystic fibrosis
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possible link to SIDS
|
prone sleeping position
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Group of chronic disorders characterized by impaired movement and posture
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cerebral palsy
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When does cerebral palsy first appear?
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first few years of life
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Causes of cerebral palsy
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infection
jaundice stroke in newborns RH incompatibility long periods of asphyxia |
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What would you find during a neuro exam of an infant with cerebral palsy
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persistence of neonatal reflexes
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What are the different forms of cerbral palsy?
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spastic, dyskinetic or athetoid, ataxic, and mixed
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What form of cerbral palsy has muscle stiffness, scissors gait, weakness, hemaparetic factors, and impaired fine and gross motor skills
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apstic
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What form of cerbral palsy has uncontrolled slow movements, and speech problems?
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dyskinetic or athetoid
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What form of cerbral palsy has poor coordination, wide based gait, intention tremors, and poor sense of balance and depth perception
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ataxic
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Mixed forms of cerebral palsy consist primarily of what two forms?
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spasticity and athenoid
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In what nuero disorder do children usually have no other associated medical disorders and no mental impairment
|
cerbral palsy
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Pharmacological therapy for cerebral palsy
|
Baclofen, Botox and seizure meds
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What is Botox used for?
|
treats spasticity of muscles in cerebral palsy
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Non bacterial, nontoxic purified form of the toxin that causes botulism
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Botox
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Chemical structure like GABA which prevents spasticity
|
Baclofen
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How is Botox given
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IM
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What is Baclofen used for
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Cerbral palsy
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How do you give Baclofen
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Po and intrathecal pump
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What are the side effects of Baclofen
|
overly loose muscles, sleepiness, N/V, headache, dizziness
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possible surgery for Cerebral palsy
|
dorsal root rhizotomy
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Other major problems associated with cerbral palsy
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bladder/bowel control
drooling difficulty swallowing communication seizures |
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___ the children with cerbral palsy have seizures
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1/2
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Neural tube defect caused by failure of fetus's spine to close properly during first month of pregnancy
|
spinal bifida
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Prevention for spina bifida
|
folic acid
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Occulta Spina Bifida
|
defect is not visible externally
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Meningocele Spina Bifida
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encases meninges and spinal fluid but no neural elements
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Myelomeningocele Spina Bifida
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contians meninges, spinal fluid, and nerves
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Where is Bina bifida most often lcated
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lumbar region
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Spina bifida is associated with?
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hydrocephalus
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If exam of meningeal sac is transcluscent what type of spina bifids is it most likely?
|
meningocele
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What do you do when newborn presents with spina bifida?
|
keep in prone position, warm sterile saline dressing on site, NPO, administer antibiotics, bonding
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With spina bifida you would want to assess for?
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increased ICP
infection anal wink motor defects |
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When would you have a neurogenic bladder with spina bifida?
|
low nerve intervention between S1 and S2
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How would you correct neurogenic bladder?
|
vesicostomy
and bladder augmentation |
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What would you use for the artificial sphincter in bladder augmentation?
|
appendix
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How would you correct bowel problems?
|
continent cecostomy
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All Spina Bifida patients are place on what kind of precaution?
|
latex
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genetic origin in which there is gradual degeneration of muscle fibers
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muscular dystrophies
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treatment of muscular dystrophies
|
mainyl supportive measures
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late signs of increased ICP
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no pupil reaction and poor posturing
|
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Increased CSF in the brain
|
hydrocephalus
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hydrcephalus can be aquired by
|
meningitis or trauma to the brain
|
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What is the typical shunt used to for hydrocephalus
|
VP
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How do shunts work with hydrocephalus
|
drain excess fluid into peritineum and is reabsorbed
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revision of VP shunts should be done how often?
|
q 3-4 years
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In untreated late hydrocephalus what sign will you see?
|
sunset eyes
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acute inflammation of the meninges and the CNS
|
bacterial meningitis
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definitive diagnosis of meningitis
|
lumbar puncture
|
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tretament for meningitis
|
attack caustive agent
|
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Do pts with meningits need to be isolated
|
yes if bacterial
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Contraindications of lumber puncture
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skin infection, CV instability, coaggulation problems
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abnormal discharge odf neurons in the brain producing a sterotyped episode of abnormal behavior, feelings or motor activity
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seizure
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seizure precaution
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pad bed, let seize, leave food in
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tonic phase of seizure
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relaxed look
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clonic phase of seizure
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scrunched look
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how often are medical updates required for epilepsy patients with drivers license
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6 months to 1 year until seizure-free for five years
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Ortalani and Barlow tests are for assessing
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hip dysplagia
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deformity of the ankle and foot
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congenital clubfoot
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self limited juvenile idiopathic avascular necrosis of the femoral head
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legg-clave-perthes-disease
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entire process of legg-clave-perthes-disease lasts how long?
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18 months to a few years
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Treatment for legg-clave-perthes-disease
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prevent damage to femoral head through casting in an abduction position
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spontaneous displacement of the proximal femoral epiphysis in a posterior or inferior direction
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slipped femoral capital epiphysis
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cause of slipped femoral capital epiphysis
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unknown but maybe growth spurt and obesity
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treatment for slipped femoral capital epiphysis
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shelf procedure or pinning
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What is the most common spinal deformity
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scoliosis
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What is important to rememeber in a patient that has had harrington rod placement for scoliosis
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log roll
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trauma to joint that a ligament is torn or stretched
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sprain
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miscrospopic tear to muscle/tendon unit
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strain
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A fracture that can bend 45 degress before breaking
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bends
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Bends fracture are common in what two bones
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ulna and fibula
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A fracture with compression of porous bone
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Buckle
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Most common fracture in young children
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buckle
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Fracture where bone is angulated beyond limits of bending
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greenstick
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growth plat injuries
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epiphysis injuries
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Five Ps of ischemia from vascular injury
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Pain
Pallor Pulselessness Paresthesia Paralysis |
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regaining alignment and length of bone fragments
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reduction
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retaining alignment and length of bone fragments
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immoblization
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12 hour management for sports injuries
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RICE or ICES
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Autoimmune inflammatory disease causing inflammation of joints and tissue with an unknown cause
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juvenile rheumatoid arthritis
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